Lecture Three (Pediatric Physical diagnosis-DR.M)-Exam 1 Flashcards
What is the head circumference for a newborn man and female?
Occipital frontal circumference:
* Newborn Male 50%= 35.8cm
* Newborn Female 50%= 34.7cm
Sutures:
1. What do they allow?
2. What do they act like?
3. What is the result?
4. What do some sutures do?
5. What does one suture so?
- Allow the bones to move during the birth process.
- They act like an expansion joint. This allows the bone to enlarge evenly as the brain grows and the skull expands.
- The result is a symmetrically shaped head.
- Some sutures extend to the forehead, while others extend to the sides and back of the skull.
- One suture in the middle of the skull extends from the front of the head to the back.
How many sutures do we have and how many fontanelles?
What are fontanelles?
The space between the bones of an infant’s skull where the sutures intersect that are covered by tough membranes that protect the underlying soft tissues and brain
Cannot have closed head for growth
- What is the anterior fontanelle (soft spot)?
- When does it close?
- This is the junction where the 2 frontal and 2 parietal bones meet.
- The anterior fontanelle remains soft until about 12 months to 2 years of age.
- What is the posterior fontanelle?
- When does it closed?
- This is the junction of the 2 parietal bones and the occipital bone.
- The posterior fontanelle usually closes first between 2-3 months after birth.
What is super important and the reason why we palpate the fontanelle?
Look for size:
* Decreased: dehydration
* Increased (bulging): Infection, meningitis and hypdroceph.
What is this?
- MOLDING: Newborn head molding is an abnormal head shape that results from pressure on the baby’s head during childbirth.
- Yellow arrow: coronal suture-> feel the bump after birht d/t the fontelles overlaping
Not for C-section babies
What is this?
Breech molding: Newborn head molding that is flat on the top and elongated in the anteroposterior diameter. Usually improve significantly within the first week.
What is this?
Caput succedaneum: An edematous swelling caused by the pressure of the presenting part against the dilating cervix, overlies the periosteum with poorly defined margins and extends across the midline and over suture lines. Usually resolves over the first few days.
Cross over the midline (side to slide)
From pushing down in cerivical a.
What is this?
CEPHALOHEMATOMA: Collection of blood secondary to rupture of blood vessels under the periosteum of a skull bone that does not cross suture lines.
- Firm and bulging
- One sided-> does not cross medline
- More prone to get jandice
- Have it for months d/t having it for a long time
What is this?
Left: Caput succedaneum
Right: Cephalohematoma
What is plagiocephaly?What is the txt?
What are normal newborn eyes?
Normal greyish blue iris and the clear pupil. True color is not determined until the age of 6 months
What is this?
SUBCONJUNCTIVAL HEMORRHAGE: Breakage of small vessels during the pressure of delivery. The red area may be large or small but is always confined to the limits of the sclera. It is asymptomatic, does not affect vision, and spontaneously resolves in several days
yellow first then heal
What do these examples show and explain?
- Dark spots in the red reflex, a blunted red reflex on 1 side, lack of a red reflex, or the presence of a white reflex (leukocoria) are all indications for referral to an ophthalmologist
- White or none: can be catracts or retinoblastoma
What is this? How common is it?
ESOTROPIA: Inward deviation (turn) of one or both eyes that occurs in 1.2% of children by 7 years of age and occurs equally in males and females.
What is this? How common?
Exotropia: Outward deviation (turn) of one or both eyes that occurs more commonly between 1 - 4 yrs old, accounting for up to 25 % of all ocular misalignment in early childhood
What is a normal ear?
The normal ear is one is which all the structures (helix, antiehelix, tragus, antitragus, scaphoid/triangular fossa, and external auditory canal) are all present and well formed.
- What is ear tag and ear pit?
- How common is this?
- What are they more likely to have?
- Ear tag: Cartilage bump in front of the ear often inherited as a familial trait
- Ear Pit (preauricular pit): Located at the superior attachment of the pinna to the face and may be unilateral or bilateral.
- Both occur with a frequency of 5 to 6 per 1000 live births
- 5X more likely to have hearing issues
What is ankyloglossia?
Tongue tied: Short, thick lingual frenulum, which is a membrane connecting the underside of the tongue to the floor of the mouth. This occurs in approximately 4% of newborns
Hard for breast feeding
Trouble with speaking later on so surgery can be useful
What is an epstein peral?
Small white papules on the palate caused by epithelial tissue that becomes trapped during the palatal fusion. Occur in >60% of all newborns and spontaneously resolve in a few weeks to months.
What is a natal teeth? How common?
- They are usually part of the primary dentition of the child, so they should not be removed unless they are mobile, presenting an aspiration risk.
- Usually occur in the mandibular gum in 1:2000 - 1:3500 newborns.
What is this?
Thrush: Caused by Candida albicans, it is the most common oral fungal infection in infants and children
Breast feed babies give it to mom-> need to treat mom
What is the commonality of cleft lip and/or palate?
What is a geographic tongue?
Smooth, red, irregularly shaped patches (lesions) on the top or side of tongue, sometimes causing discomfort, can continue for days, months or years. The problem often resolves on its own but may recur.
What are the different tonsil sizes and which ones are most common?
What are these?
- Left: normal tonsils (+2)
- Right: tonsil hypertrophy (+3)
What is this?
What is this?
Tonsillectomy
